UMMC’s Multidisciplinary Thyroid, Pituitary and Neuroendocrine Tumor Treatment Centers make international headlines

A stint as a volunteer paramedic working with firefighters in her hometown of Rockville, Md., sparked the interest of Karen Pitman, MD, to pursue a medical career, a dream fulfilled via time spent in the Navy. She relocated to Mississippi to pursue the opportunity to work solely with head and neck patients.

Medical oncologist Robert Darryl Hamilton, MD, stays quite busy seeing patients, teaching and finding new and better ways to provide treatment for people with head and neck cancers. In addition to committee work involving services and finding ways that specialists from different spectrums can better collaborate on complex cases, he sees 15 to 20 patients daily. 

Kristen Otto, MD, who removes cancerous tissue and reconstructs the area, often working with other head and neck care team surgeons, was captivated early on by the intricacy of head and neck surgeries. 

Microvascular surgeon Gina Jefferson, MD, shifted her educational focus from biomedical engineering to medicine after an encounter with a single patient. She calls head and neck “the most beautiful (part of the) anatomy.”

Majid Khan, MD, works daily to locate tiny targets of cancerous cells growing inside a patient’s head or neck.

All five physicians have a strong common bond as collaborators on the multidisciplinary team treating thyroid disorders at the University of Mississippi Medical Center (UMMC).

Teamwork Exemplified

UMMC’s multidisciplinary thyroid treatment center was established in May 2007, consisting of physicians who specialize in endocrine, hormonal, and metabolic disorders, surgery including head and neck, imaging including nuclear medicine, and pathology. Specifically, the team involves the Division of Endocrinology and Thyroid Center director Shema Ahmad, MD; Department of Ear Nose & Throat (ENT) otolaryngologists Pitman, Otto, and Jefferson; Department of Radiology and Nuclear Medicine chief Vani Vijayakumar, MD; Division of Oncology’s Hamilton; and others.

“There are a lot of complex treatment plans, treatments and after care,” said Otto, who leads the Head and Neck team within University Cancer Care, and also teaches and serves on several committees at the local and national level of professional organizations. Part of her ongoing research involves sentinel lymph node biopsy in head and neck cancer, and the development and design of institutional treatment protocols for head and neck cancer patients.

“Our tight-knit multidisciplinary approach results in superior survival and better quality of life,” said Hamilton, who co-wrote “Anemia” in McGraw-Hill’s 2009 Pharmacotherapy in Primary Care.

Otto, who surgically works through hair-like nerve endings to retain facial movement, and reconstructs a patient’s jaw or palate so they may eat, talk and breathe naturally, said the team sees some of the most complex cases in Mississippi. “I like the team members who are dedicated to individual patient care and producing the best outcome for the patient,” said Otto, who has published papers such as “The Diminishing Diagnosis of Follicular Thyroid Carcinoma” in Head Neck.

Jefferson, a former student athlete who ran track and field, teaches and practices head and neck surgery at UMMC and the G.V. “Sonny” Montgomery Veterans Affairs Medical Center. Among her recently co-authored published works: “Evaluation of Immunohistochemical Fine Sectioning for Sentinel Lymph Node Biopsy in Oral Squamous Cell Carcinoma,” in Otolaryngology-Head Neck Surgery.

An India native, Khan combines reading images with teaching and research at UMMC and the VA Medical Center, where he was named Teacher of the Year.

Vijayakumar and Koch presented worldwide including Cape Town, Africa, on endocrine aspects in nuclear medicine and were recently named award winners for an educational exhibit on the topic parathyroid adenomas presented at the Radiological Society of North America, Chicago, IL.

A Deep Well

“This is just a glimpse of what’s happening here at UMMC in endocrinology,” said Christian A. Koch, MD, PhD, professor and director of the UMMC Division of Endocrinology. “For instance, we just received the great news of acceptance to have another medical article published in the international peer-reviewed journal HORMONES with an ‘impact factor of > 2,’ soon to be listed in PUBMED. The topic of this article is the diagnosis and management of hyperglycemic emergencies.”

Koch co-authored this paper, together with endocrine fellowship program director Jose Subauste, endocrine fellow Niyutchai Chaithongdi and vice chair and critical care physician Stephen Geraci, which provides a practical up-to-date review of the precipitating factors, diagnosis, management and secondary prevention of the hyperglycemic emergencies diabetic ketoacidosis and hyperglycemic hyperosmolar state to assist critical care physicians and hospitalists caring for these patients.

“Limitations of various guidelines include the implementation in settings with an infrastructure different from the one used to compose the guideline of a respective country, state, or community,” said Koch, a native of Nuremberg, Germany, and certified diabetologist DDG who focuses on the pathogenesis of endocrine tumors and serves as a reviewer for top-tier medical journals including the New England Journal of Medicine, PNAS, JCEM, and others and on the international editorial board of the Journal of Thyroid Research. “For type 1 diabetics, the transition period from adolescence to adulthood is particularly critical to prevent repetitive hospital admissions. Hyperglycemic emergencies are usually preventable; patients should be educated and assured continuous access to healthcare to prevent recurrences of these conditions.”

As an expert in rare endocrine tumors including those of the pituitary, thyroid, and adrenal glands, Koch and UMMC specialists—endocrinologist Gabriel I Uwaifo, MD, and pathologist Steven A Bigler, MD—and also leading physicians from the Mayo Clinic and University of Texas healthcare system, in 2009 published on the clustering of sebaceous gland carcinoma, papillary thyroid carcinoma and breast cancer in a woman as a possible new cancer susceptibility disorder.

“Although the patient was also exposed to radiation from a pipe used in the oil field industry, the constellation of neoplasms in this patient suggested the manifestation of a known hereditary susceptibility cancer syndrome. However, testing for the most likely candidates such as Muir-Torre and Cowden syndrome proved negative.”

Underrecognized Conditions

Later in 2009, Koch, along with Marion Wofford, MD, professor and director of the Division of General Internal Medicine and Hypertension, and colleagues from the University of Miami and National Institutes of Health, co-wrote a chapter on endocrine hypertension, a term assigned to states in which hormonal derangements result in clinically significant hypertension (see www.endotext.org, under section editor George Chrousos, and the new APP “Endocrinology and Endocrine Emergencies,” editor: Leslie De Groot).

At UMMC, “we have a large pituitary tumor database and the only pituitary tumor center in Mississippi,” said Koch, pointing out that invasive neuroradiologist R. Buciuc, MD, routinely receives referrals from physicians throughout Mississippi and neighboring states to perform inferior petrosal sinus sampling, a procedure needed to diagnose Cushing's disease. “At UMMC, we have a study protocol on Cushing's syndrome and we are the sole study site in Mississippi.” The pituitary tumor team includes widely-published neurosurgeon Andrew Parent, MD, and neuropathologist Jonathan Fratkin, MD.

“These tumors and other neuroendocrine tumors, as we recently have also learned from the death of (Apple chairman) Steve Jobs, who had a neuroendocrine tumor of the pancreas, are often underrecognized, as they are rather rare and many colleagues don’t know much about them,” said Koch. “’Evidence’ as some people define it these days, is dependent on the publication of single cases or case series, as is true for most rare endocrine conditions. As pointed out by Michael Kidd, editor of JMCR, we need practice-based evidence in the era of evidence-based practice.”

In collaboration with the University of Leipzig, Koch has most recently (December 2011) published on the rare neuroendocrine tumor pheochromocytoma in one of the most prestigious endocrine and medical journals, Nature Reviews Endocrinology, with an impact factor >9. “A special honor, similar to the Case Records of the New England Journal of Medicine, consisted of the fact that this paper made it as a continuing medical education (CME) article,” said Koch.

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